Anterior translation post anterior pilon fixation. Are we missing something?

J. Mcevoy, A. Gomaa, L. Mason

Introduction: Anterior pilon fractures are uncommon injuries to the ankle. Fixation of the fracture is commonly undertaken, however concomitant injury to the anterior talofibular ligament (ATFL) is not commonly addressed. There are no current studies assessing talus translation in anterior pilon fractures. Objective: To assess incidence of persistent talus anterior translation in pilon fractures affecting the anterior plafond.

Methods: A retrospective analysis of a prospectively collected database in a major trauma centre was undertaken to establish eligible patients. All patients with pilon fractures with anterior components undergoing reduction and fixation were included. Intraoperative and weightbearing postoperative radiographs were assessed for fracture reduction and anterior talus translation. The Topliss Classification was used for pilon type characterisation.

Results: A total of 23 patients were identified who could be included in the study. The mean age of patients included in the study was 37.70 years (95% CI 31.74, 43.65). All patients were judged to be anatomically reduced. No patients underwent ATFL reconstruction. There were 13 patients (56.50%) with persistent anterior talus translation. There was no significant difference in persistent talar anterior translation (p=.708) between coronal type (58.82%) or sagittal type (50%) pilon fracture as categorised by the Topliss classification.

Conclusions: Over half the patients in this study with pilon fractures with an anterior component had persistent anterior talus translation post fixation despite being anatomically reduced. The fracture mechanism to sustain an anterior pilon is likely to injure the ATFL. Ligamentous reconstruction should be considered in anterior pilon fracture types to try and prevent persistent anterior talar translation.